F A C T SE u r o p e a n A g e n c y f o r S a f e t y a n d H e a l t h a t W o r k

ENh t t p : / / a g e n c y . o s h a . e u . i n t

Skin sensitisers

Introduction

Occupational skin diseases are estimated to cost the EU EUR 600million each year, resulting in around 3 million lost working days.They affect virtually all industry and business sectors and force manyworkers to change jobs.

The Agency is producing a series of factsheets on occupationalsafety and health information about dangerous substances for theEuropean Week for Safety and Health at Work 2003. This factsheetcontains information on skin sensitisers as well as preventivemeasures for skin exposure.

What causes occupational skin problems?

Occupational skin problems are caused by contact with certainsubstances at work. They usually affect the hands and forearms,most likely to touch the substance, but may spread to other parts ofthe body. Early signs include dryness, redness and itching of the skin.The skin may become swollen, cracked, scaly and thickened andblisters may develop.

How quickly a skin reaction develops depends on the strength orpotency of the substance and how long and how often it touchesthe skin. These skin changes often improve when the worker is awayfrom work, such as during weekends and holidays.

Workers regularly exposed to liquids and using water, which canbreak down the skin’s natural defence barrier, are most at risk.Exposure of the skin to extreme temperature and solar radiation andbiological risks also contribute.

What are allergic skin diseases?

The human immune system is built to defend the body againstinfectious and other harmful outside invaders. Sensitisation is aspecific form of immunisation; such over-reactivity is called allergy.The agents that cause allergy in skin are skin allergens.

What are skin sensitisers?

There are two different kinds of skin sensitisers, chemicals andproteins in natural materials. Chemical allergy in skin usuallydevelops over time, while protein allergy can occur very quickly.

In some cases allergens can cause skin symptoms when inhaled oringested. It is also possible for skin contact with chemicals to causerespiratory allergic symptoms. Some dangerous substances, e.g.from plants and some pharmaceuticals, may cause photoallergicreactions in combination with exposure to sunlight.

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Chemical

Nickel

Chromium

Cobalt

Colophony

Epoxy resins

Isocyanates

Acrylates/methacrylates

Formaldehyde

Paraphenylenediamine

Textile dyes andpigments

Glutaraldehyde

Fragrances

PharmaceuticalsAntibiotics

PreservativesChloracetamide,formaldehyde releasers,isothiazolinones(Kathons), parabens

Rubber chemicalsThiuram accelerators,phenylenediaminederivatives

Solventsd-Limonene,Ethylene diamine

Industrial enzymes

Natural rubber latexproteins

Animal proteins

FoodstuffDecorative plants

Protective gloves,medical instruments

Animal dander, epitheliaand urine

Vegetables, plantsFlourSpices

Health care workers,hairdressers

Farmers, laboratoryanimal handlers

Farmers, florists, kitchenworkers, cooks, foodindustry, bakers

Source

Metals, soldering,nickel-containingequipment such asscissors, coins

Cement, leather gloves,metals, tanningmaterials

Resins, electronic solderflux, adhesives

Paints and varnishes

Insulation foams, paintsand varnishes

Paint plasticisers, dentalmaterials, syntheticnails, plastics, adhesives

Cosmetics, plastics,resins

Oxidative hair colorants

Cleaning agents

Metal cutting fluids,cosmetics, woodpreservatives, water-based paints, glues

Paints, cleansers,degreasers

Amylases in flour,proteases in detergents,etc

Occupation

Platers, electronicsindustry, metalworkers,hairdressers, cashiers

Construction workers,metal industry, leathertanning

Metal smelting

Resin industry,musicians, dancers,electronics industry

Painters, electronicsindustry, manufacturing,construction

Construction, painters,manufacturing

Dental workers,beauticians, metalworkers

Hairdressers, healthcare, manufacturing,textile finishing,embalming

Hairdressers

Textile workers

Health care, cleaners,papermaking, offshore

Cleaning personnel,hairdressers

Health care

Metal workers,beauticians, masseurs,hairdressers, woodworkers

Health care workers,hairdressers, rubberindustry

Metal workers, painters,assembly line workers,mechanics, printers

Food and detergentsindustry, cleaners

Metals, incl. dust and fumes

Examples of sensitisers and occupations at risk

Proteins from natural materials

Resins and plastics

Colorants/dyes

Disinfectants

h t t p : / / a g e n c y . o s h a . e u . i n t F a c t s

E u r o p e a n A g e n c y f o r S a f e t y a n d H e a l t h a t W o r k

© European Agency for Safety and Health at Work. Reproduction is authorised provided the source is acknowledged. Printed in Belgium, 2003

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Preventing exposure

Assess the jobs where exposure is likelyAssess substances used at work including any new substancesintroduced. The agents at risk of being skin sensitisers should beknown and the exposure amount assessed.

Some chemical skin sensitisers are classified and listed in EUregulations. They are labelled (1) with R-phrases R 43 “May causesensitisation by skin contact” or R 42/43 “May cause sensitisation byinhalation and skin contact”.

Lists of occupational exposure limits also provide indications ofsensitising potential, (2) and the potential to penetrate the skin, the“skin notation” (3). Very small amounts of a substance, which can befar below the concentration limits for labelling and the occupationalexposure limit, can provoke an allergic reaction in sensitive persons.

Eliminate or substitute harmful substancesReplace the skin sensitiser or modify the work process to avoidexposure, for example introduce ‘no touch’ techniques by designingmaterial packages in such a way that accidental contact may beavoided.

If replacement is not possible, reduce exposureThe number of exposed workers, the time and frequency ofexposure and the concentration of skin sensitiser should all be keptas low as possible. Model instructions and guidelines are available (4).If work practices are changed, changes of skin exposure should beevaluated.

Skin contact with the substances can be reduced:

1. Install devices in work operations, such as local exhaustventilation, splash guards and screens.

2. Provide suitable, adequate and accessible protectiveequipment (PPE). It has to comply with EU regulations (5). Makesure equipment for personal use, such as gloves, is carefullyselected, worn, maintained and replaced. General selection guidesfor gloves (6) and clothing (7) are available. Large differences inpermeability and resistance to various chemicals exist, dependingon manufacturer, material, model and thickness. Therefore, reviewa glove-resistance chart from the manufacturer you intend to buyfrom. Protective gloves and boots can cause allergies themselves,especially when made of latex rubber or leather tanned withchromium-containing substances. Avoid their use.

3. Draw up a skin protection plan

Include measures and instructions for:■ skin protection before work■ skin cleansing during and after work■ skin care after work

taking into account■ type of contamination, i.e. oily, greasy or strongly clinging such

as lacquer, resins, adhesives■ moist and wet working areas: metal working fluids, water,

washing and cleansing solutions■ skin protection when wearing gloves■ protection from UV radiation when welding and working

under strong sunlight.

4. Provide adequate washing facilities

5. Good housekeeping and personal hygiene:■ protect the whole body, including face and neck■ keep skin clean■ make sure protective clothing is clean and intact

■ remember to change, especially disposable, clothing andgloves frequently, as chemicals can accumulate on andpenetrate through them

■ keep workplaces clean, including machinery and tools■ make sure diluted chemicals, e.g. cleaning fluids, are diluted to

the correct strength – if they are over strength, they are morelikely to cause skin problems.

Monitor skin problems and act on any findingsAny skin disorder which is suspected to be associated with workshould be reported immediately. Medical examination should beperformed. Fellow workers who do the same job may also havesimilar skin problems.

Inform, consult and train workers to avoid skin contact with harmfulsubstances as far as possible.

Make sure workers■ know about the skin sensitisers they are exposed to■ have been taught safe work practices■ use the controls provided■ have been trained to use equipment for personal use■ know how to check their skin■ understand the benefits and limitations of skin protection

measures such as the use of pre-work skin creams■ are consulted

• on the results of risk assessment and monitoring• when substituting dangerous substances• on the choice of PPE.

Further information

Other factsheets available in this series on dangerous substances andfurther information are also available at http://osha.eu.int/ew2003/.This source is being continually updated and developed.

Chromium in CementWater-soluble Chromium VI, which is classified as carcinogenicand sensitising, can induce painful, disabling, allergic eczemain people exposed to wet cement preparations widely used inthe construction industry. A study of 5,000 builders workingon the Channel Tunnel found that half had skin problems andthat half of these individuals were sensitive to Chromium VI.

Reducing chromium VI by adding 0.35% ferrous sulfate to thecement is possible and has been shown to reduce the adversehealth effects. In Member States where this technique hasbeen introduced, the number of eczema cases resulting fromexposure to cement has been dramatically reduced.

The European Commission is at the moment consideringrestricting the use of cement with high contents of Chromium VI.These cement products have had to be labelled as sensitisingsince 2002.

European Agency for Safety and Health at WorkGran Vía, 33, E-48009 Bilbao

Tel. (34) 944 79 43 60, Fax: (34) 944 79 43 83information@osha.eu.int

(1) According to Directives 67/548/EEC 1999/45/EC, and amendments relating to requirements for testing, classification, packaging and labelling of dangerous substances and preparations(2) Mostly marked with an “S” in the OEL tables(3) Use of the ‘Skin’ notation is intended to alert employers that air sampling alone is insufficient to accurately quantitate exposure and that measures to prevent significant absorption through

the skin may be required.(4) E.g. for the printing industry http://www.hse.gov.uk/pubns/ipex11.pdf or http://www.druckindustrie.ch/images/d/arbeitssicherheit/Haut2.pdf(5) Directive 89/686/EC relating to personal protective equipment(6) E.g. http://www.hse.gov.uk/pubns/indg330.pdf(7) E.g. http://www.osha-slc.gov/dts/osta/otm/otm_viii/otm_viii_1.html#3